Development of a Novel Coding Scheme to Explore Interactions in the Co-Production of Public Services with Priority Populations

This study focuses on the development of a reliable coding scheme (CP-CODER) for studying interaction dynamics during the co-production of a public service involving priority communities. CP-CODER addresses the need to involve priority populations in the development of public services, an approach that has been recognized as difficult because of the high possibility of their experiencing negative health, social, and economic outcomes. The coding scheme was designed to capture group dynamics and forms of public engagement by adopting and integrating existing theoretical frameworks in the public service management and qualitative method literature. Coding was conducted on the transcripts of four co-production workshops, which included 26 family caregivers, three local health and social care service provider representatives, and five researchers involved in the coproduction of new community-based services. One category was added to the two theoretical frameworks. The kappa ranged from 0.70–1.00 for the eight variables and the 26 individual items. The overall kappa was 0.91, while the overall percentage of agreement was 91.16%. The results of the pilot test showed the importance of integrating and managing three dimensions in coproducing with a priority population: the turn-taking, the content, and the level of abstraction of the discussion. The findings of this study have enhanced and supported both practitioners and researchers in co-producing services, ensuring the equal contribution of all participants, even those whose voices are rarely heard

Providing freedom or financial remuneration? A cross-sectional study on the role of monetary and legal incentives on COVID-19 further booster vaccination intention in the Italian context

Vaccine hesitancy became a more and more important issue during the COVID-19 pandemic. Due to the emergence of new variants, many international health agencies have already begun administering booster doses of the vaccine in response to these threats. Studies have emphasized the effectiveness of different types of incentive-based strategies to increase vaccination behaviors. The purpose of the present study was to identify the correlation between different types of incentives (legal or financial) with people’s intentions to get a COVID-19 booster vaccine. We conducted a cross-sectional study between 29 January 2022 and 03 February 2022. An online quantitative survey was carried out in Italy. One thousand and twenty-two Italian adults were recruited by a professional panel provider. Descriptive statistics were computed for the five variables concerning the incentives (monetary, tax, fee, health certification, travel) toward vaccination. A general linear model (GLM) was then computed to compare the scores of the five different variables within the subjects. The general linear model showed a significant within-subjects main effect. Post-hoc comparisons showed that among the financial incentive, the monetary reward is rated lower than all the others. Tax and fees both resulted lower than both the legal incentives. Finally, COVID-19 health certification and travel did not result significantly different from each other. This study offers an important contribution to public policy literature and to policymakers in their efforts to explain and steer booster vaccination acceptance while facing an ongoing pandemic

Spotlight on the patient health engagement model (PHE model): A psychosocial theory to understand people\u2019s meaningful engagement in their own health care

The concept of patient engagement in health care is gaining more and more attention not only in the scientific literature, but also as a requirement in the everyday practices of health care organizations. In general terms, the growing body of literature devoted to patient engagement is mainly inspired by the sociological and public health perspectives, which have generated various theories and models trying to explain how people become active agents in their health and care management. However, theories focusing on the psychosocial dimensions intervening in the patient engagement experience are still limited. This paper proposes a psychosocial perspective on patient engagement and discusses the Patient Health Engagement model, which is an evidence-based psychological theory built on extensive qualitative narrative research and literature analysis aimed at explaining patient engagement and its development in the patients\u2019 perspective. The model has been applied to orient patient and professional educational interventions and has contributed to the generation of the first scientific measure of the psychological experience of patients\u2019 engagement in their own care (Patient Health Engagement scale). According to this theory, patient engagement is a developmental process that involves the recovered patients\u2019 ability to have a life projectuality and goal directedness \u2013 even if living with a disease. The paper will also discuss the theoretical origins of this model and will conduct a critical comparison of the theory with the Transtheoretical Model of Change developed by Prochaska and the five-stage grief theory by Kubler-Ross

Da un modello assistenziale "centrato sul paziente" ad un "ecosistema di engagement": il modello ASUGI

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COMMUNI.CARE (COMMUNIcation and Patient Engagement at Diagnosis of PAncreatic CAncer) : Study Protocol

Background: In many cases of pancreatic adenocarcinoma (PDAC), the diagnosis comes as a surprise to the patient, who often faces a disease that is already at an advanced stage, with poor prognosis. The clinical visit during which the diagnosis is communicated together with the first information regarding the planned treatments is of paramount importance. We hypothesize that the clarity of such information can influence patients' engagement and thus their level of compliance. Aims: This study aims to collect (a) quantitative data on the level of PDAC patient engagement, (b) data on the rate of understanding of the information received from the doctor, and (c) data on level of compliance; the possible associations between these variables will be analyzed. Methods: This is a single-center, observational, cross-sectional cohort study on patients diagnosed with PDAC, approved by the Ethics Committee of the San Raffaele Hospital. As no preliminary data are available on the association between PDAC patients' understanding rate and their level of engagement and of compliance, no power calculation is possible. This is a pilot study, aimed at enrolling at least 45 PDAC patients during a period of 3 months. Conclusion: COMMUNIcation and Patient Engagement at Diagnosis of PAncreatic CAncer (COMMUNI. CARE) will be the first study specifically investigating whether there is a relation between PDAC patients' engagement, rate of understanding at the time of diagnosis, and compliance.Peer reviewe

How older citizens engage in their health promotion: A qualitative research driven taxonomy of experiences and meanings

Objectives: In this qualitative study, we provide an in-depth exploration of older people\u2019s experiences and subjective meanings concerning their engagement in health promotion as well as the emotional and pragmatic difficulties they face during their engagement. Methods: The study was designed according to the Ethnoscience method, which implies a participatory process that values patients\u2019 linguistic expressions to deeply understand the phenomena under the investigation and to give it a meaning. Using this method, thanks to repeated rounds of interviews and q-sorting task, participants created a dictionary, with the assistance of researcher, to describe the phenomenon of interest. They agreed on a shared taxonomy of meanings and experiences related to the phenomenon. Twenty-five North Italian older citizens participated in this study. Results: Participants described a shared taxonomy of health engagement experiences by depicting three main positions (i.e., \u201clocked position\u201d; \u201cawakening position\u201d; \u201cclimbing position\u201d), which represented different experiential domains grouped by participants into four main semantic areas (e.g., physical care, soul care, daily lifestyle, contact with ageing). Each position is characterized by specific emotions, personal representations of meaning and healthy behaviours that may sustain or hinder older citizens\u2019 engagement in health promotion. Conclusions: The results of the present study suggest the importance of deeply understanding older peoples\u2019 experiences and their subjective meanings of health promotion. Particularly, the results showed how their engagement in health promotion is framed in a complex system of psychological meanings, which may sustain or hinder their ability to adopt healthy behaviours. A deeper understanding of older citizens\u2019 lived experiences, their doubts, and their difficulties in engaging in health promotion may offer some important cues for orienting interventions in this area

NURSES\u2019 INTERVENTIONS TO PROMOTE CANCER PATIENT ENGAGEMENT AND RELATED OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS PROTOCOL

Background and aim of the work. Due to the ageing of cancer patients, new approaches that require a more active participation in the self-management of cancer treatment at home are needed. Nurses are strategic in improving the patient\u2019s engagement capability in this regard. Knowing which interventions are more effective for the promotion of patient engagement could be useful to improve the effectiveness of the care provided. Therefore, this study aims to systematically review nursing interventions or programs that promote patient engagement in oncological nursing care and summarizing the main evidence related to their impact on relevant clinical and psychosocial outcomes. Method. This is a systematic review and meta-analysis protocol based on Cochrane Handbook for the systematic review of interventions. We will search the most important electronic databases (PUBMED, CINAHL, EMBASE, SCOPUS, ISI Web of Science, Cochrane library) to find out which patient engagement interventions (active adult patient involvement) are implemented in oncological settings and understand what is the effectiveness of these interventions on the outcomes reported in the literature. The GRADE methodology will be used to synthetize the evidence. If possible, also a meta-analysis will be performed. We registered the study protocol on the PROSPERO database (N\ub0 CRD42020146189). Discussion and Conclusion. To our knowledge, this is the first systematic review to address this clinical question in the field of oncology. This review will offer health professionals indications on the most frequently adopted patient engagement interventions and verify their clinical effectiveness. Furthermore, any gaps in the scientific literature will be highlighted

The psychosocial impact of flu influenza pandemics on healthcare workers and lessons learnt for the COVID-19 emergency: a rapid review

Objectives: during a pandemic, healthcare workers (HCWs) are essential to the health system response. Based on our knowledge, little information is available regarding the psychosocial impact on HCWs or interventions for supporting them during pandemics. Therefore, the study aimed to assess available literature on perceived stress and psychological responses to influenza pandemics in HCWs and identify implications for healthcare practice and future research. Methods: this is a rapid review of the literature. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis. Results: across all the studies both qualitative and quantitative HCWs working during the epidemic reported frequent concerns regarding their own health and the fear of infecting their families, friends and colleagues. Moreover, social isolation, uncertainty, fears of stigmatization and reluctance to work or considering absenteeism were frequently reported. Moreover, many studies highlighted a high prevalence of high levels of stress, anxiety and depression symptoms, which could have long-term psychological implications in HCWs. Conclusions: this rapid review offers an overview of the major concerns regarding HCWs' psychosocial well-being and possible preventive strategies, which could be useful for the current COVID-19 outbreak and similar future pandemics. Studies suggested to invest on preventive psychological, social, family and physical support and to guaranteeing reasonable work conditions and others in order to protect HCWs from the long-lasting psychological effect of the COVID-19 pandemic. Electronic supplementary material: the online version of this article (10.1007/s00038-020-01463-7) contains supplementary material, which is available to authorized users

Cremona Beside Caregivers: una ricerca per assistere chi assiste

Stato dell’arte In Europa la fascia di popolazione over 65 rappresenta il 19% della popolazione, mentre In Italia ha già superato il 22%. Tuttavia, la distribuzione di queste persone non è omogenea sul territorio, ma presenta una maggiore presenza nelle aree rurali dove tale fascia di popolazione ha un alto rischio di esclusione sociale e fragilità (Burholt & Dobbs, 2012). Sebbene siano stati posti per molto tempo in secondo piano, i bisogni delle persone anziane nelle aree rurali sono di primario interesse, soprattutto per la diversità di richieste e di necessità che ci si aspetta di trovare in queste aree rispetto a zone con buona presenza di servizi. In questi contesti, infatti, un ruolo cruciale nell’assistenza agli anziani viene svolto dai caregiver, che si trovano largamente caricati del supporto all’invecchiamento (Sixsmith et al., 2014). Nel 2009 è stato infatti rilevato che in Italia due terzi delle cure necessarie alle persone anziane venivano assicurate da loro parenti (Troisi & Knodratowitz, 2013), anche per garantire c alle persone anziane di poter continuare a vivere nei contesti a loro cari, attraverso pratiche di “aging in place” - cioè di invecchiamento attivo nel proprio contesto comunitario di vita (Rodríguez-Rodríguez & Sánchez-González, 2016). In questo scenario, la provincia di Cremona rappresenta per sue caratteristiche territoriali e sociali un osservatorio privilegiato per studiare le necessità della popolazione anziana e di chi li assiste, anche nell’ottica di promuovere una rappresentazione propositiva e partecipe di questa fase della popolazione alla co-definizione dei servizi e dei prodotti ad essi dedicati. Date queste premesse, l’obiettivo di questo progetto di ricerca è di condurre una mappatura degli stakeholders sul territorio Cremonese, delle risorse presenti e dei bisogni scoperti, al fine di orientare attività di supporto dedicate prioritariamente al target dei caregiver. Approccio metodologico A copertura dei suddetti obiettivi si è definito un disegno di ricerca multi-fase e multi-metodo così composto: Fase 1 - analisi sistematica dei database statistici Istat, volta a descrivere le caratteristiche socio-demografiche della popolazione anziana cremonese, sia attuale che in trend storico, comparandola con quella nazionale; Fase 2 - Desk analysis per identificare i servizi sanitari, socio-sanitari e sociale attivi sul territorio a favore dell’anziano fragile che vive a casa, in termini di ruoli e i professionisti coinvolti, le collaborazioni formali e informali tra professionisti e tra Enti; regimi dietetici proposti agli anziani (i.e. in famiglia nelle RSA, nelle cooperative, nell’ADI…); Fase 3 - Interviste qualitative biografiche a stakeholders locali (i.e. rappresentanti Fondazioni, Cooperative, Comuni, RSA, associazioni di volontariato…) riconosciuti per la loro centralità nel rapporto con anziani e caregiver, al fine di approfondire le loro esperienze, l’analisi delle priorità e delle necessità presenti sul territorio. Principali risultati I dati demografici confermano la tendenza alla senilizzazione della provincia di Cremona: è la seconda provincia con la percentuale di over 65 della Regione Lombardia, dopo Pavia (Elaborazione Ires L. Morosini su dati Istat, 2019). Negli ultimi venti anni, tale percentuale è cresciuta dal 23,7% nel 2002 al 26,8% di oggi (Istat, 2021). La durata di vita attesa degli anziani cremonesi oltre i 65 anni resta inferiore a quella media lombarda: 22,1 anni nelle donne e 18,4 negli uomini, di cui la maggior parte trascorsi “senza limitazioni funzionali” (Elaborazione Ires L. Morosini su dati Istat, 2019). Tuttavia, nel 2016 il 10,8% degli ultrasessantacinquenni residenti nella Provincia di Cremona beneficiava di un’indennità di accompagnamento, il 13,8% tra le donne e il 6,9% tra gli uomini di quella fascia di età. Dalla mappatura degli stakeholders sono stati identificati 36 enti del settore sanitario, 35 del terzo settore e 7 istituzioni chiave per lo studio del fenomeno degli anziani e dei loro caregiver. Dalle prime interviste biografiche condotte emerge la necessità di dotarsi di strumenti di mappatura sistematica della fragilità senile; inoltre gli stakeholder sottolineano l’importanza di creare spazi di lavoro multidisciplinari che possano operare nelle diverse aree di ci la fragilità senile si compone (sanitaria, sociale, alimentare, economica, …). Conclusioni I primi risultati confermano il bisogno del territorio cremonese nell’ambito dell’assistenza agli anziani fragili: le attività e le risorse finora messe in campo necessitano di essere orchestrate per operare in maniera efficace e sostenibile per il territorio stesso e per le persone che lo vivono

Un percorso co-costruito di implementazione di pratiche di coinvolgimento attivo in un contesto di cure integrate: l'esperienza di ricerca partecipativa con l'ASUGI di Trieste

Introduction: In this article we can find the report of the main phases of the collaboration between ASUGI and the Università Cattolica del Sacro Cuore of Milan from 2015 to today. Methods: During these years, a path of activation and implementation of engagement practices within ASUGI has been developed, from basic training on the tools for monitoring and supporting engagement to the selection of a group of operators involved in a participatory path as "trainers to trainers", up to the grafting of engagement practices within the individual patient education paths in the different sectors of ASUGI. Results and Conclusions: This contribution is an exemplifying scenario that can be useful for other health structures that want to undertake a similar path